INTotal Health : Quality Improvement Program

Quality Improvement Program

Our goal at INTotal is to provide you with the highest quality of care for you and your family. Accountability and achieving excellence is very important to us. We are guided by a number of standards and practices to ensure that you are getting the right care. Here are some examples of how quality informs everything that we do:

Results-based projects across the health plan led by our Quality Management (QM) program
Sound advice from internal and external experts
National standards set by the National Committee for Quality Assurance (NCQA)
Current research that informs the criteria we use
First-hand experience of case managers who know our members’ needs

Our QM program is dedicated to excellence in the quality of service and care our members receive, and we are always on the lookout for ways to improve our program. Our comprehensive QM program:

Holds itself to the NCQA and State Quality Assessment and Performance Improvement program standards
Routinely monitors and evaluates the care and services provided to members
Performs studies across all care and service areas to ensure ongoing evaluation and improvement of the program
Encourages both members and providers to talk to us about recommendations for improvement
Identifies areas where we can promote and improve patient safety

The INTotal Health governing body oversees the Quality Management committee structure and it includes:

A quality management committee
A medical advisory committee
A credentialing committee
A utilization management committee
A pharmacy and therapeutics committee

We measure our clinical performance and service satisfaction using the Medicaid Healthcare Effectiveness Data and Information Set (HEDIS) standards and results from our Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.

Child CAHPS Survey
Questions	2015 Score	2016 Score	# of 2016 Responses
Getting Needed Care (% Always and Usually)	81%	87%	234
Getting Care Quickly (% Always/Usually)	87%	90%	255
How Well Doctors Communicate (% Always/Usually)	90%	92%	346
Customer Service (% Always and Usually)	84%	88%	188
Shared Decision Making (% Yes)	67%	74%	103
Health Promotion (% Yes)	68%	66%	N/A
Coordination of Care	78%	81%	126

Adult CAHPS Survey
Questions	2015 Score	2016 Score	# of 2016 Responses
Getting Needed Care (% Always and Usually)	81%	83%	227
Getting Care Quickly (% Always/Usually)	80%	89%	231
How Well Doctors Communicate (% Always/Usually)	89%	82%	267
Customer Service (% Always and Usually)	81%	86%	126
Shared Decision Making (% Yes)	75%	81%	143
Health Promotion	72%	72%	N/A
Coordination of Care	82%	84%	161

HEDIS Scores
Measure	Measurement Year 2014	Measurement Year 2015
Adult BMI Assessment	77.86%	72.03%
Weight Assessment, Counseling for Nutrition, and Physical Activity for Children/Adolescents (Counseling for Nutrition)	59.85%	58.80%
Childhood Immunization Status (Combination 3)	71.78%	69.91%
Lead Screening in Children	67.40%	67.79%
Breast Cancer Screening	45.11%	48.41%
Cervical Cancer Screening	50.85%	55.94%
Medication Management for People With Asthma (Total – Medication Compliance 75%)	41.12%	49.22%
Controlling High Blood Pressure	55.50%	49.11%
Comprehensive Diabetes Care (HbA1c Testing)	85.89%	87.86%
Follow-Up After Hospitalization for Mental Illness (30-Day Follow-Up)	48.26%	59.45%
Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life	78.69%	76.90%
Adolescent Well-Care Visits	46.26%	50.23%